Therapeutic Advances in the Treatment of Holmes Tremor: Systematic Review
| Autor: | Robert S. Eisinger, Kai-Liang Wang, Christine Smith, Adolfo Ramirez-Zamora, Christopher W. Hess, Joshua K. Wong, Michael S. Okun, Aparna Wagle Shukla, Wei Hu, Samuel Carbunaru |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Deep brain stimulation Trihexyphenidyl medicine.medical_treatment Deep Brain Stimulation Globus Pallidus law.invention Holmes tremor Levodopa 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Internal medicine Tremor medicine Humans Resting tremor business.industry Rubral tremor General Medicine Postural tremor medicine.disease Neuromodulation (medicine) Anesthesiology and Pain Medicine Neurology Thalamic Nuclei Neurology (clinical) business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Neuromodulation : journal of the International Neuromodulation Society. 25(6) |
| ISSN: | 1525-1403 |
| Popis: | Objective We aimed to formulate a practical clinical treatment algorithm for Holmes's tremor (HT) by reviewing currently published clinical data. Materials and methods We performed a systematic review of articles discussing the management of HT published between January 1990 and December 2018. We examined data from 89 patients published across 58 studies detailing the effects of pharmacological or surgical interventions on HT severity. Clinical outcomes were measured by a continuous 1-10 ranked scale. The majority of studies addressing treatment response were case series or case reports. No randomized control studies were identified. Results Our review included 24 studies focusing on pharmacologic treatments of 25 HT patients and 34 studies focusing on the effect of deep brain stimulation (DBS) in 64 patients. In the medical intervention group, the most commonly used drugs were levetiracetam, trihexyphenidyl, and levodopa. In the surgically treated group, the thalamic ventralis intermedius nucleus (VIM) and globus pallidus internus (GPi) were the most common brain targets for neuromodulation. The two targets accounted for 57.8% and 32.8% of total cases, respectively. Overall, compared to the medically treated group, DBS provided greater tremor suppression (p = 0.025) and was more effective for the management of postural tremor in HT. Moreover, GPi DBS displayed greater benefit in the resting tremor component (p = 0.042) and overall tremor reduction (p = 0.022). Conclusions There is a highly variable response to different medical treatments in HT without randomized clinical trials available to dictate treatment decisions. A variety of medical and surgical treatment options can be considered for the management of HT. Collaborative reseach between different institutions and researchers are warranted and needed to improve our understanding of the pathophysiology and management of this condition. In this review, we propose a practical treatment algorithm for HT based on currently available evidence. |
| Databáze: | OpenAIRE |
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